Once a month, Arentsoa, who is 18 months old, and her mother Larissa visit the community health and nutrition site in Ambatombositra for Arentsoa to be weighed and examined. During the visit, Arentsoa meets and plays with other children and tastes dishes prepared by the mothers during their cooking class at the site.
The opening of the Ambatombositra community site has been beneficial for Larissa and other mothers in the village. Malala, mother of three-year-old Frédéric, who regularly visits the site, says, “The site and the community workers who work there provide us with tremendous services. They are like mothers to us. I trust them, and I follow their advice to the letter.”
Community health and nutrition workers are essential to implementing the Improving Nutrition Outcomes Project or FAFY Program in Madagascar. This initiative aims to increase use of reproductive, maternal, child health and nutrition (RMCHN) interventions while improving key nutrition behaviors known to reduce stunting.
In Madagascar, stunting is a significant development issue that has long concerned the government. Stunting occurs when children do not grow properly due to lack of nutritious food, access to health services, and clean water. The results can impede cognitive and physical development throughout life. Inadequate breastfeeding practices and insufficient maternal nutrition during pregnancy also contribute to stunting.
In 2016, Madagascar had the fourth-highest prevalence of stunting globally. Through the Improving Nutrition Outcomes Project supported by the World Bank and the Power of Nutrition multi-donor trust fund, Madagascar initiated a 10-year program in 2018 aimed at alleviating chronic malnutrition in children under five years old. This program focuses on improving quality and coordination between nutrition and health sectors from community levels upward.
“Despite the strong connection between health and nutrition, primary care and community-based services in these two areas in Madagascar have remained separate and uncoordinated. The FAFY Program has facilitated connecting these two crucial sectors,” explains Cedric Ndizeye, Senior Health Specialist at the World Bank in Madagascar. “There is evidence that priority interventions for nutrition and health can bring significant benefits for children, their families, and the country."
Nearly 9,000 community workers have been trained using a new approach combining health and nutrition interventions. Additionally, more than 4,500 community health sites have been established. Training was provided at over 1,080 primary healthcare centers to improve service quality while equipping them with necessary products.
At community sites level services now available include early pregnancy detection; home counseling; follow-up visits; nutrition education; cooking demonstrations; growth monitoring; early childhood stimulation; lipid-based nutrient supplementation (LNS); management of acute malnutrition; detection/treatment of common childhood diseases among others.
The FAFY Program initially covered seven regions but now extends to 13 out of Madagascar's 23 regions reaching over two million individuals including 1.2 million children under five years old along with 440 thousand pregnant women according DHS data prevalence dropped nearly three percentage points nationally from42% down39 point eight percent first seven regions reduction even more significant dropping52 point four percent48 point four same period
“The program builds upon an adaptive learning approach that is dynamic," explains Lisa Shireen Saldanha Senior Nutrition Specialist World Bank
In2017 Government visited Peru learn how country halved stunting brought key lessons targeting supply incorporating promote demand research initiative Mahay study expanding preventive supplements feasibility integrating activities collaboration part study demonstrated LNS component reduced nine percentage points findings informed design scaling young selected areas
Chronic long term impacts hampers natural potential significant human economic progress nations economic cost consume nation’s GDP requires immediate decisive action case losses associated accounting prioritizing substantial cognitive increasing future incomes
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